Miles to Go, Promises to Break

We are assured that whatever version of healthcare reform is passed, it will save us money and provide more access to healthcare. Promises can be made, but the laws of economics trump words.

There are indeed ways to reduce health care costs. Increasing competition and/or increasing innovation can reduce costs by increasing supply. Demand can be reduced; demand for health care falls when consumers take more responsibility through self-care, diet, and exercise. Demand can also be reduced by lowering the quality of the product or by rationing care. With a process controlled by politicians who are ignorant of economics and by lobbyists from the medical and pharmaceutical industry, which door do you think will be chosen? If you answered “ration care or reduce quality” you are correct. Fundamental reforms that increase competition will not be accepted by doctors; increasing consumer responsibility is against the interests of the pharmaceutical industry who depends upon millions of Americans taking drugs for conditions that could be treated in safer and less invasive ways.

I am sure of one thing—any healthcare reforms passed by government will take us more towards top-down, centralized healthcare and move us further away from a free-market. This will in turn create the need for even more “reform” that moves us further from a free-market. There are indeed many problems with our current healthcare system, but unlike our cousins in Canada and the United Kingdom, a dire shortage of healthcare is not one of them.

Allow me to share a tale. Last week, I began to experience light flashes in the corner of my eye; a few days later I began to experience what appeared to be black filaments floating in front of my field of vision. From that starting point, I will contrast my experience with the experience of a United Kingdom (UK) citizen who had similar symptoms.

My experience: My wife calls a Blue Cross hotline and speaks to a registered nurse. The nurse advises my wife to get me to an emergency room immediately as I was at risk of suffering from a detached retina.

UK citizen: “I went to see my GP (I’m from the UK). He didn’t seem to know much about it so he had to resort to looking in his pocket book of family health (which really gave me a lot of confidence). Despite his clear lack of knowledge, he suddenly decided he was an expert and told me that I was just worrying about nothing, everyone gets them etc. But I told him that this had just suddenly come on over a week, but he just said I was a worrier and that there was really nothing wrong.”

My experience: We consider our options. There is a local rural hospital close by or there is Dartmouth-Hitchcock Medical Center which is about an hour and half drive away. We decide that should I need surgery, Dartmouth-Hitchcock is the place to be. I pack an overnight bag and off we go.

UK citizen : “I wasn’t satisfied with that so I went to the opticians who were surprisingly well equipped with digital retina cameras etc. The optician was very nice and took great interest in finding out was wrong. He could clearly see that something was wrong (and unofficially made the correct diagnosis) and referred me to a specialist.” [Brownstein’s note—the only place that our UK cousin got good care was from the optician who is not part of the NHS (National Health Service.)]

My experience: I arrive at Dartmouth-Hitchcock where, in the emergency room, I am triaged into a high priority category. An ophthalmological surgeon is immediately called in who does a very thorough and caring exam. Fortunately, mine is a benign condition called vitreous separation, there is absolutely no retinal damage. I am referred to a local ophthalmologist for follow-up checkups. My wife and I go out to lunch, feeling greatly relieved.

UK citizen: “When I eventually got to see the specialist (this is the NHS I’m talking about, so it took a while), he said I had a detached vitreous in both eyes. He then shooed me away like I was wasting his time.”

Now a fair criticism of my account would be something like this: “You have insurance that allowed you to seek the best possible care. What about someone who has no insurance? A fair enough question indeed; I would not want to go through my experience having either no money to pay for care or to be told that it would be weeks or months until I could see a specialist.

Now, I realize that the current proposals do not call for socialized healthcare as in the Canada or the United Kingdom. But this is a slippery slope—more regulations cause more problems, which breed more regulations, which create lower quality care and less access. The answers lie in true market-based reforms that remove barriers to competition and give more access at lower costs to more Americans. Access to a waiting list, like the UK citizen experienced, is not access at all.

Producers and Thieves

Today it was announced that Kenneth Feinberg, the Treasury Department’s special master for compensation, “will slash compensation for the 25 highest-paid employees at seven firms receiving large sums of government aid.” In a free-society, there is no room for a “compensation czar;” the problem will be gone instantly when the aid is eliminated.

In his classic book The State, the German sociologist Franz Oppenheimer taught there are two means to wealth: economics and political. In his inimitable blunt style Murray Rothbard sums up the difference between the two:

There are only two ways for men to acquire wealth. The first method is by producing a good or a service and voluntarily exchanging that good for the product of somebody else. This is the method of exchange, the method of the free market; it’s creative and expands production; it is not a zero-sum game because production expands and both parties to the exchange benefit. Oppenheimer called this method the “economic means” for the acquisition of wealth.

The second method is seizing another person’s property without his consent, i.e., by robbery, exploitation, looting. When you seize someone’s prop­erty without his consent, then you are benefiting at his expense, at the expense of the producer; here is truly a zero-sum “game”–not much of a “game,” by the way, from the point of view of the victim. Instead of expanding production, this method of robbery clearly hobbles and restricts production. So in addition to being immoral while peaceful exchange is moral, the method of robbery hobbles production because it is parasitic upon the effort of the producers.

With brilliant astuteness, Oppenheimer called this method of obtaining wealth “the political means.” And then he went on to define the state, or government, as “the organization of the political means,” i.e., the regularization, legiti­mation, and permanent establishment of the political means for the acquisition of wealth.

In other words, the state is organized theft, organized robbery, organized exploitation. And this essential nature of the state is high­lighted by the fact that the state ever rests upon the crucial instrument of taxation.

What good is a theory if it is not applied? I don’t know if Max Keiser has ever read Oppenheimer or Rothbard, but listen to Keiser as he colorfully explains the differences between firms like Google who earn their wealth through production and the banking industry who he explains has obtained its wealth through theft.

Is this mere hyperbole on Keiser’s part? While I can’t say, as Keiser does, that accounting fraud is currently being committed by the banks, I can say that the bonuses being paid would not be paid on a free market. These bonuses are being financed, in part, by direct transfer of taxpayer’s money and by record low interest rates that indirectly transfer resources from productive savers into the hands of banks and debtors. The latter is a direct consequence of Federal Reserve policy.

For many, Keiser’s words create cognitive dissonance; and cognitive dissonance may cause an instant rejection of his message. Cognitive dissonance “is an uncomfortable feeling caused by holding two contradictory ideas simultaneously.” Dissonance, according to psychologist Carol Tavris, “produces mental discomfort, ranging from minor pains to deep anguish; people don’t rest easy until they find a way to reduce it.” After all, aren’t our government officials looking out for our well-being? Surely they are more concerned about the well-being of all Americans than they are concerned about the bankers? If you believe the answer is “yes” to both questions, then Keiser’s message will produce dissonance in you. Yet, the facts suggest Keiser is more right than wrong:

• “An analysis of Mr. Geithner’s calendars…shows that Mr. Geithner had contact with top executives at Citigroup, Goldman Sachs and JPMorgan Chase more than 80 times during his first seven months at Treasury.” Source here.
• “Goldman Sachs posted near record trading profits in the third quarter of 2009.  The projected 2009 Goldman Sachs bonus pool will be around $20 billion, a near record amount. Therefore the average pay out per employee could be more than the $661,490.” Source here.
• “As a whole financial firms “accounting for more $350 billion in federal bailout funds, increased these perks and benefits 4 percent on average last year, according to an analysis of corporate disclosures filed in recent months.” Source here.

Without government bailouts, these result would not have been possible—failing firms do not pay bonuses.

None of this is to say that officials like Treasury Secretary Geithner are evil individuals who are consciously trying to undermine the American economy. Instead, perhaps Geithner has his own form of cognitive dissonance as he tries to internally justify his behavior. He may begin with a truth that a healthy banking system is essential to the American economy; and then, he may resolve his dissonance by adding the false premise that JPMorgan, Chase, Citibank, etc. are essential to a healthy banking system.

Nothing could be further from the truth. The financial institutions that are being subsidized took reckless risks. The economy cannot have a sustained recovery until those firms which made bad loans and who can not survive without government assistance are liquidated. Nothing in the conduct of these financial institutions suggests that they have reformed. They will continue to seek the political means to wealth; and like a drug addict who would destroy his family before giving up his habit, they and their government enablers will do the same to America. And when they are through, they will relieve their cognitive dissonance by chanting the big lie—there was nothing else we could have done.

A Government by the Irresponsible and for the Irresponsible

We know the accepted narrative by now: Swine flu is potentially deadly. Pharmaceutical companies in partnership with the government have made a heroic effort to get a vaccine ready for mass immunization. Anyone who does not take the vaccine is endangering the public health.

In their must read essay, “Does the Vaccine Matter?” in the November issue of The Atlantic, Shannon Brownlee and Jeanne Lenzer ask: “But what if everything we think we know about fighting influenza is wrong? What if flu vaccines do not protect people from dying—particularly the elderly, who account for 90 percent of deaths from seasonal flu?”

Brownlee and Lenzer don’t ask these questions rhetorically. They cite specific medical studies that call into question the entire flu shot mythology. Alarmingly, they give a glimpse into the power of the flu lobby. Lisa Jackson, is a physician and senior investigator with the Group Health Research Center in Seattle. When she began to question studies which claimed astonishing benefits from the flu vaccine, she related her experience to  Brownlee and Lenzer: “People told me, ‘No good can come of [asking] this.’” She was warned, “‘Potentially a lot of bad could happen’ for me professionally by raising any criticism that might dissuade people from getting vaccinated, because of course, ‘We know that vaccine works.’ This was the prevailing wisdom.”

When you read the essay by Brownlee and Lenzer you ask yourself, “What is motivating those who push the flu vaccines?” Many clearly are sincere professionals who believe in what they do. But others deserve the title that Lila Rajiva gave them: “Swine Floozies.” Rajiva defines a swine floozy: “A cheap tart who’ll sell you anything to make a buck…They sell you government cures. In almost all cases, these cures are worse than the disease.”

“Government cures”? “Aren’t the vaccines developed by free-market pharmaceutical companies?” you might wonder. It is no free-market when your primary customer is the government, and when in July, Secretary of Health and Human Services Kathleen Sebelius “granted both the vaccine makers and government immunity from lawsuits that could result from the swine flu vaccine.”

The best judges of risk are the actuaries who work for insurance companies. Why is it difficult to buy insurance for beachfront property in a hurricane zone? The simple answer is that there is a large risk of loss. In a free-market, there would be no government insurance in hurricane zones. You would agree to take the risk or buy insurance at a prohibitively high price. Would there be less development? Of course! And that’s how it should be.

Would there be less swine flu vaccine without government involvement? The answer, as with housing development in a hurricane zone, is “yes.” Individuals who wanted to take the vaccine anyway would be free to sign a waiver that released the pharmaceutical company from potential damages. Or, alternatively, pharmaceutical companies could produce vaccines that insurance companies recognize as safe. I won’t debate the safety of the swine flu vaccine, but for me the judgments of the insurance companies are compelling.

Brownlee and Lenzer ask a second critical question: “And what if the expensive antiviral drugs that the government has stockpiled over the past few years also have little, if any, power to reduce the number of people who die or are hospitalized?” Their answer:

As with vaccines, the scientific evidence for Tamiflu and Relenza is thin at best. In its general-information section, the CDC’s Web site tells readers that antiviral drugs can “make you feel better faster.” True, but not by much. On average, Tamiflu (which accounts for 85 to 90 percent of the flu antiviral-drug market) cuts the duration of flu symptoms by twenty-four hours in otherwise healthy people. In exchange for a slightly shorter bout of illness, as many as one in five people taking Tamiflu will experience nausea and vomiting. About one in five children will have neuropsychiatric side effects, possibly including anxiety and suicidal behavior. Between 2001 and 2007 in Japan, where Tamiflu is liberally prescribed, the drug may have been responsible for 50 deaths from cardiopulmonary arrest, according to Rokuro Hama, the chair of the Japan Institute of Pharmacovigilance.

Indeed, Japan has banned the use of Tamiflu for teenagers after several kids jumped out of windows while on the drug. Yet, in spite of its dubious effectiveness, billions of taxpayer dollars have been spent stockpiling these drugs– another boondoggle for the pharmaceutical companies. Rajiva gives us “Tami-Floozy”—“Tami-Floozies make a direct killing from investing in the drugs sold to cure the diseases hyped by the other floozies. Donald Rumsfeld is the best-known of the type.”

Brownlee and Lenzer explain how vaccination may be counterproductive:

In the U.S., by contrast, our reliance on vaccination may have the opposite effect: breeding feelings of invulnerability, and leading some people to ignore simple measures like better-than-normal hygiene, staying away from those who are sick, and staying home when they feel ill. Likewise, our encouragement of early treatment with antiviral drugs will likely lead many people to show up at the hospital at first sniffle.

Brownlee and Lenzer are too kind. This feeling of invulnerability leads people to continue their irresponsible ways and to become potential breeding grounds for disease. Nothing we can do will guarantee health, but there are steps we can take that tilt the odds in our favor. Sugar laden diets suppress the immunological system, while exercise boosts it. This year, the average American will eat over 200 pounds of disease-promoting sugar and corn syrup and will consuming only about 8 pounds of disease-fighting broccoli. They will drink their sugar laden sodas and eat their desserts while watching propaganda programs instructing them to be properly terrified of the flu. The stress induced from these fear-laced programs further compromises the body’s immunological system.

I would never presume to know what is right for anybody else, but it is simply a fact that millions of people who take little responsibility for maintaining their health will be lining up for their vaccines. If Brownlee and Lenzer are correct, at best, we have done no better than to waste billions and to encourage irresponsible behavior. We have the irresponsible government that our irresponsible behavior deserves.

The Missing Ingredient

The film The Ramen Girl tells the story of Abby, a twenty-something American women who is stranded in Tokyo after being dumped by her boyfriend. She decides to stay. To earn a living, she begs a tyrannical Japanese ramen chef, who doesn’t speak a word of English, to teach her the art of making ramen. In Japan, ramen making is a high art.

Abby and her teacher clash, but the ramen master begins to soften towards Abby. Yet, despite all of her hard work, Abby cannot make a decent ramen bowl. In desperation, the master takes Abby to see his own mother. The scene unfolds as Abby prepares a bowl of ramen and serves it to the master’s mother:

Ramen master’s mother: Her broth is bland.

Ramen master: I wonder why? She’s mastered the techniques perfectly.

Mother talking to her son: Sometimes too much technical training can get in the way.

Mother talking to Abby: You cook with your head. Understand? Your head is full of noise. You must learn to cook from the quieter place deep inside of you.

Abby: How?

Mother:  Each bowl of ramen that you prepare is a gift to your customer. The food that you serve your customers becomes part of them. It contains your spirit. That’s why your ramen must be an expression of pure love; a gift from your heart.

Is this new age blather? Or, are we hearing business wisdom? After all, you can sell many things without having much regard for your customer. But, what about in today’s emerging economy where frugality will be the norm?

My wife enjoys an occasional cup of coffee. She recently told me the story of a coffee shop in town that she visited once and then did not return to for over a year. Why? It is a small shop, she related, and the server was not very welcoming. Drinking a cup of coffee, like eating ramen, is an experience. This is nothing new; companies like Starbucks were built on the experience they offer.

But does Abby really need to be so responsive to her customers that her work becomes an expression of love? The workday of a ramen chef is very long and repetitive. Many of her customers she may never see again. Kahil Gibran asked the question, “And what is it to work with love?” He answered his own question with advice that echoes that of the ramen master’s mother:

It is to weave the cloth with threads drawn from your heart, even as if your beloved were to wear that cloth.
It is to build a house with affection, even as if your beloved were to dwell in that house.
It is to sow seeds with tenderness and reap the harvest with joy, even as if your beloved were to eat the fruit.
It is to charge all things you fashion with a breath of your own spirit…

Inspiring words, indeed. But what about the noise in Abby’s head that is getting in her way? Gibran asks us, “When you work you are a flute through whose heart the whispering of the hours turns to music. Which of you would be a reed, dumb and silent, when all else sings together in unison?”

Gibran is offering a pointer. We must allow ourselves to be found by life—to be found by the music that wants to sing through us in harmony with every living thing. A ramen cook becomes a ramen master when his cooking nourishes more than the body. A cook’s ingredients may be high quality, but there is more to cooking than ingredients. Are we part of the web of life that unites us all? Or, have we cut ourselves off? To ask the question is to be ready to receive the answer.

Abby is clearly trying to find her place in the world; but understandably given her circumstances, she is preoccupied with herself. The way out for Abby is to give even more of herself. This giving is enlivening rather than exhausting. Abby is called upon to have an intimate relationship with her customers—she is called upon to share fully of the gifts of her spirit. Doing so, she is united with her customers in their human journey; they are not mere objects playing their parts in Abby’s journey.

Eric Butterworth wrote, “Love is not an emotion that begins in us and ends in the positive response of another.” That kind of love is merely a deal destined to fall apart. Love doesn’t begin in us. We allow Love to flow through us when we can laugh at the noise in our head which is focused on the gratification of the endless demands of our own ego.

As she gives more, Abby gets more. But what she gets she could not have planned for or even conceived of. Some people go through life expecting to get before they give. Others go through life giving but then keeping score to see if what they receive back is in balance with what they give. Neither of these ways of being in the world will allow life to sing through us. We are the ones placing boundaries on the notes that can be played. If we continue to see the world through the eyes of our egos, life becomes very small and tedious.

In many of our organizations, work is tedious. Employees don’t share their gifts fully, interpersonal conflict is the norm, and dubious decision-making is routine. For the successful corporations in the future, a culture which supports the idea that their products and services are an expression of pure love will become a business necessity. Consumers will be buying more of what adds real value to their lives, and by economic necessity, they will be buying less of what merely fills the void in an unfulfilled life.